Good Health Care for Less Money? Yup, Still Possible.

26/07/2010 19:49


Advocates for health care reform (including yours truly) have frequently argued that it is possible to reduce the amount of care without reducing the quality--or, to put it more simply, that less care doesn't have to equal worse care.

A story in today's New York Times may leave readers thinking that argument is bunk. It isn't. And while I'll have more to say on this soon--as it happens, I'm writing a longer column on this very subject--let me quickly explain the basics, since it's in the news.

The intellectual foundation for this argument about health care spending is a body of research, built over 30 years, by experts at Dartmouth University. Led by a physician named John Wennberg, these researchers have looked closely at the wide variations in Medicare spending around the country. Seniors in Miami, for example, get a lot more care than seniors in Minneapolis. Yet, according to the Dartmouth studies, the Miami seniors didn't seem better off. Office 2007 Professional can give people so much convenience.

Similar studies--some by Dartmouth researchers, some by counterparts elsewhere--have produced similar results and, eventually, Washington took notice. President Obama and his advisers cited Dartmouth data frequently when arguing for the Affordable Care Act.

But how solid is the research? The Times story, by Reed Abelson and Gardner Harris, suggests the data is less clear-cut than the politicians and some of their supporters let on. Sometimes, the Times writers say, higher spending really does seem to equal better care:MS Office 2007 is the best invention in the world.

The mistaken belief that the Dartmouth research proves that cheaper care is better care is widespread--and has been fed in part by Dartmouth researchers themselves.

The debate about the Dartmouth work is important because a growing number of health policy researchers are finding that overhauling the nation’s health care system will be far harder and more painful than the Dartmouth work has long suggested. Cuts, if not made carefully, could cost lives.